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Naturopaths say new state rules are a bad RX

New state regulations defining what constitutes a prescription drug for naturopathic doctors were announced Tuesday by the Department of Commerce, Community and Economic Development. The Alaska State Medical Association, which advocates on behalf of licensed medical doctors, supports the new regulations. One naturopathic doctor says the new regulations may put many naturopaths in the state out of business.

The Alaska Legislature mandated the licensure of naturopathic doctors in 1986. In the U.S., naturopaths are regulated in 17 states and the District of Columbia. South Carolina and Tennessee prohibit the practice of naturopathy.

The new regulation now says anything requiring a prescription is a prescription drug, and therefore out of the hands of naturopaths. The state statute previously read, “‘prescription drug’ includes a controlled substance or other medicine commonly requiring a written prescription from a physician licensed under AS 08.64. ‘Prescription drug’ does not include a device or herbal or homeopathic remedy or dietetic substance in a form that is not a controlled substance.”

C.W. Jasper, a naturopathic doctor in Juneau, says the new regulations mean he can no longer prescribe and administer something as innocuous as a vitamin C shot because it’s categorized as a substance requiring a prescription.

“Previously, naturopathic doctors have been able to use prescriptive nutrients, basically injectable vitamins and minerals and these new regulations prevent that from happening. Basically now a naturopath can only prescribe what people can already get over the counter,” Jasper said. “In Alaska, what little prescriptive authority we have is now being taken away from us.”

Jasper said the new regulations are illegal because they don’t conform to the original statute licensing naturopaths.

“Why is there suddenly this need to change regulations and deprive of a scope of practice that we’ve had for two decades? We don’t understand why this sudden urge exists,” Jasper said. “It’s a reasonable question to ask a judge if this is right.”

In 2011, Dr. Emily Kane — another Juneau naturopath — signed a mediated consent agreement with the Department of Commerce agreeing that she would no longer “prescribe or recommend a medicine that requires prescription in order to be filled by an Alaska pharmacist.”

The facts stated in the consent agreement say that Kane wrote more than 400 prescriptions between Jan. 1, 2006 and April 17, 2008 and that Kane inquired in 1996 about her authority to prescribe and administer certain drugs such as epinephrine, penicillin and silver nitrate. The department informed her that if a product requires a prescription that a naturopath may not prescribe or recommend it. In February of 2008, the department received notice that Kane administered an injection of procaine, an anesthetic sometimes used to treat arthritis, which prompted action by the department.

A 2010 state House Bill that would have established an Alaska Naturopathic Medical Board didn’t make it out of the Finance Committee. Another House Bill introduced in 2012 that would have explicitly excluded medicine derived from a natural source, with the exception of controlled substances, didn’t make it out of the Labor and Commerce Committee.

The Alaska State Medical Association has opposed attempts by naturopaths to expand or assert their practice. A Jan. 15 letter to the Department of Commerce from then ASMA president Dr. J. Ross Tanner called for the department to interpret state statute to explicitly deny naturopaths the ability to access any drugs, even herbal and natural ones, that require prescription.

“… through recent events, including the consent agreement referenced above and legislative testimony it is clear that some read and interpret the construct of the current regulation to allow some prescriptive authority for naturopaths,” Tanner wrote. “On Feb. 9, 2012, in Senate Labor and Commerce the State of Alaska, Department of Law Assistant Attorney General Andy Harrington testified that the statute very clearly prohibits naturopaths from giving, prescribing or recommending a prescription drug and that the Division has consistently taken a position that the current regulations did not forge any kind of exception to the statutory prohibition.”

A March 2010 letter from then ASMA president Dr. Brion Beerle opposed the establishment of an Alaska Naturopathic Medical Board.

“ASMA simply does not believe that the naturopaths’ education and training is comparable to that of an MD or DO,” Beerle wrote. “Thus, the expansion of the scope of practice found in HB282 is not warranted.”

ASMA Executive Director Michael Haugen said the organization wouldn’t immediately give comment on the new regulations.

Jasper said the opposition from mainstream medical doctors is unfounded.

“For some of these naturopathic doctors that will be put out of business, they can go down to Washington or Oregon and be given full prescriptive authority,” Jasper said. “As big as they are as a profession, they still don’t want competition. Why would these medical doctors even have an opinion on our practice?”